Business strategy and healthcare

This past week frustration reigned in my office as I saw more cancer patients in one week than I have ever seen in a week. The big problem is that 2 of these patients with advanced disease have no health care insurance or their insurance that they have will not cover their surgery and further treatment. What to do? Wait for the Democrats running for President to give us Medicare for all??

People have to understand that one of the patients has a type of Medicare, however, her policy will not cover further treatment. Remember this for those of you who still believe that Medicare-for-all will solve all our problems.

The other fairly young patient with advanced cancer has a job but no healthcare insurance. But as a dedicated physician, I am going to operate on her in the office only charging her for supplies, which is probably what I will do for the “Medicare type of coverage.

But doctors can’t do this on a routine basis otherwise they couldn’t pay their bills, pay salaries to their staff and pay for their malpractice, healthcare insurance, pay their mortgage and put food on the table. What then? Less and fewer students would choose to go into medicine and care for us all.

And what happens when both of these patients need chemotherapy, radiation treatment, and or immunotherapy? Who is going to pay for their advanced care?

Harris Meyer reported that Healthcare-spending growth would raise at an annual average of 5.5% over the next decade, slightly faster than in the past few years, due to the aging of the baby boomers and healthcare price growth, the CMS Office of the Actuary projects.
Because that growth will exceed gross domestic product growth, the CMS predicts healthcare’s share of GDP will rise from 17.9% in 2017 to 19.4% in 2027, according to a report in Health Affairs released Wednesday. That’s close to the 19.7% the CMS actuary predicted in its last national health expenditure report a year ago.
Price increases are expected to account for nearly half the growth in personal healthcare spending from 2018 to 2027, with an increase in utilization and intensity of services accounting for an additional third of spending growth. The authors of the report said prices will increase by 2.8% for outpatient prescription drugs, 2.6% for hospitals, and 1.8% for physicians.
Overall outpatient drug spending is projected to increase by an average of 6.1% per year over the next decade, driven by increased utilization of new drugs and a modest increase in prices.
These spending trends could boost public support for policy proposals to regulate prices and boost competition for healthcare services and drugs. For instance, Democratic proposals for Medicare-for-all and public plan options would pay providers at Medicare prices, which generally are significantly lower than what private insurers pay.
“The cost trend will make it easier to fund a Medicare-for-all or public option plan, because the price differential between what Medicare and the private sector pay allows you to save money by paying Medicare rates,” said Gerald Anderson, a health policy professor at Johns Hopkins University.
But he and other experts say the projected spending growth over the next decade—which is sharply less than the 7.3% average annual growth from 1990 to 2007—may not be sufficiently alarming to spur politically thorny policy changes.
“There’s nothing here that ought to catch people by surprise,” said Gail Wilensky, a health economist at Project Hope who formerly served as Medicare administrator. “These (projections) offer no reason to celebrate, but they’re not unreasonable. And they’re probably higher than what we’ll actually see because there will be public or private-sector interventions of some sort.”
The projected 5.5% annual rate of growth from 2018 to 2017 would exceed the 5.3% rate during the Affordable Care Act coverage expansion period from 2014 to 2016, as well as the 3.9% growth rate during the Great Recession period of 2008-2013.

Medicare spending is expected to grow faster than Medicaid or private insurance spending due to the aging of the large Baby Boom population into the program, peaking this year. That will produce a 7.4% average annual Medicare spending growth rate over the next decade, compared with 5.5% for Medicaid and 4.8% for private insurance.
Medicaid expenditures will rise partly because of the new Medicaid expansions in Maine and Virginia and expected expansions in Idaho, Nebraska, and Utah.
Per-capita spending growth rates for Medicare, Medicaid, and private insurance are expected to be similar, at 4.7%, 4.1%, and 4.6%, respectively.
The 2017 congressional repeal of the Affordable Care Act’s penalty for not buying insurance, effective this year, will moderate national health spending growth by reducing private insurance enrollment, the report said. That repeal is projected to result in a net increase in the number of uninsured Americans by 1.3 million, to 31.2 million in 2019.
Still, 90.6% of Americans are expected to have coverage in 2019, down from 90.9% last year.
Overall price inflation for healthcare goods and services is expected to average 2.5% over the next decade, compared with 1.1% for 2014 to 2017. The CMS actuaries said prices will rise at least partly because of the weakening of restraining factors such as patient cost sharing, selective contracting by insurers, and improvements in productivity in physicians’ offices.
“Half the growth in spending will be price growth in spite of the fact that all these Baby Boomers are entering Medicare,” said Anderson, citing a famous 2003 Health Affairs article he co-authored. “It’s still the prices, stupid.”
Hospital spending will grow an average of 5.7% per year over the next decade, up from 5.1% in 2019, the actuaries said. Hospital prices will rise due to tighter labor markets and continued wage increases for hospital employees, including nurses.
Average annual spending growth for physician and clinical services is projected at 5.4% for the coming decade, as physician pay is driven up by the shortage of doctors to meet the needs of the aging population.
The economists in the Office of the Actuary who wrote the report acknowledged that their projections can be off for various reasons. For instance, last year they projected that healthcare spending in 2018 would increase by 5.3%. In their new report, they projected spending in 2018 grew only 4.4%.
Sean Keehan, one of the authors, said the 2018 projected spending growth was lowered in the new report due to slower-than-expected Medicaid enrollment and spending increases, smaller out-of-pocket spending hikes, and a more sluggish jump in prescription drug costs.
Anderson said the overall takeaway from the new CMS report is that the U.S. still hasn’t seriously bent the cost growth curve. “There’s no turndown,” he said. “We keep waiting for that turning point and the actuaries aren’t seeing that turning point at least through 2027.”

So, what do we do? Do we listen to the Democrats running for President and wrap our arms around Medicare for All or do we fix the Affordable Care Act or do we design another system?

Seattle Mayor signs Medicare-for-all resolution

Can the left’s ‘free-for-all’ Medicare work?

Fox News Brie Stimson noted that as the national health care debate rages on, Seattle has decided to support Medicare-for-all.

Last month, Seattle Rep. Pramila Jayapal introduced a bill, the Medicare for All Act of 2019, that would transition Americans to single-payer government-paid health care but does not explain how the government will pay for the plan.

This week, Seattle Mayor Jenny Durkan signed a City Council resolution in support of Jayapal’s bill, making Seattle the first city to back a Medicare-for-all bill.

“The U.S. has among the worst health outcomes in the developed world despite spending roughly 19 percent of our nation’s gross domestic product (GDP) on health care,” Seattle Council member. Lorena González said in a statement. “A single-payer system would improve health outcomes while lowering the cost of medical care and insurance.”

Editorial: Medicare for All isn’t the only way to go

Merrill Goozner reported that Healthcare providers and insurers are gearing up to oppose Medicare for All. No surprise there. Insurers can’t look kindly on legislation that would put them out of business. And providers are deathly afraid of losing the high rates from private insurers that cross-subsidize government-funded patients.

But at the same time as they mobilize to defeat M4A, shouldn’t they be outlining what they support?

Here’s what M4A advocates want to achieve. The first is universal coverage. Sadly, we’re again moving away from this basic human right due to actions by the Trump administration to undermine the Affordable Care Act. They want lower prices. Insurance premiums for employers and out-of-pocket expenses for individuals and families continue to rise faster than wages or economic growth.

Finally, they want an end to the frustration engendered by a system that erects roadblocks between physicians and patients. These range from insurer rules requiring prior authorization to seemingly arbitrary limits on what doctors can perform or prescribe.

Is M4A the only way to solve these problems? Of course not. When it comes to covering the uninsured, the ACA worked just fine. Massachusetts, the first state to implement an ACA-like program, had an uninsured rate of 2.5% in 2017. That’s not the 0% of most Organisation for Economic Co-operation and Development countries, but pretty close.

Politics are at the root of the ACA’s failures—not its Rube Goldberg design. The Supreme Court allowed states to opt out of the Medicaid expansion. And when the GOP-controlled Congress eliminated the individual mandate, key to making rates on the exchanges affordable, it reduced sign-ups, raised premiums and stopped the expansion dead in its tracks.

How about service prices? M4A would set prices at Medicare rates, which are well below private insurance rates but higher than Medicaid rates (both Medicaid and the Children’s Health Insurance Program are eliminated in Sen. Bernie Sanders’ M4A bill). But that’s not where most of its savings come from.

According to a sympathetic analysis from the University of Massachusetts at Amherst, half of M4A’s savings come from reducing provider and insurer administrative overhead. Another quarter comes from lower drug prices.

But these are one-time savings that will do little to stop the upward spiral of hospital and physician costs, which account for two-thirds of all spending. That’s where we get to the third issue supposedly addressed by M4A: the administrative hassles and limits imposed on obtaining care.

These aren’t eliminated by an expanded public system. They simply transfer the policing of waste, fraud, and abuse from private hands to public hands and change the motivation from padding profits to protecting taxpayers. In the past, Medicare has done a better job than private payers for one simple reason: it can impose price controls. Providers have responded by shifting much of the shortfall to their private-paying patients.

There are alternatives for achieving M4A’s goals. They include private companies offering exchange policies with well-defined coverage rules and strict limits on out-of-pocket costs; all-payer rate-setting or global budgets to slow the rate of price increases; merging Medicaid with Medicare (leaving long-term services and supports to the states), which would give private employers and families rate and tax relief; and establishing all-stakeholder oversight councils to develop medically appropriate utilization rules.

There’s more. The point is that in the post-Trump era, the U.S. will once again begin moving toward a healthcare system that is universal and affordable with high-quality care for everyone.

A multipayer approach could be like Germany and Switzerland, which rely on private insurers that are regulated to a much greater extent than currently exists in the U.S. Or it will be a single-payer system like Canada, Great Britain or France. Each delivers better results at a lower cost than the U.S.

I’m agnostic on which way to go. I’m still waiting for providers and insurers to articulate their vision.

Some ‘Cheaper’ Health Plans Have Surprising Costs

Julie Appleby reports that one health plan from a well-known insurer promises lower premiums — but warns that consumers may need to file their own claims and negotiate overcharges from hospitals and doctors. Another does away with annual deductibles — but requires policyholders to pay extra if they need certain surgeries and procedures.

Both are among the latest efforts in a seemingly endless quest by employers, consumers, and insurers for an elusive goal: less expensive coverage.

Premiums for many of these plans, which are sold outside the exchanges set up under Affordable Care Act, tend to be 15 to 30 percent lower than conventional offerings, but they put a larger burden on consumers to be savvy shoppers. The offerings tap into a common underlying frustration.

“Traditional health plans have not been able to stem high-cost increases, so people are tearing down the model and trying something different,” said Jeff Levin-Scherz, health management practice leader for benefits consultants Willis Towers Watson.

Not everyone is eligible for a subsidy to defray the cost of an ACA plan, and that has led some people to experiment with new ways to pay their medical expenses. Those experiments include short-term policies or alternatives like Christian-sharing ministries — which are not insurance at all, but rather cooperatives through which members pay one another’s bills.

Now some insurers — such as Blue Cross Blue Shield of North Carolina and a Minnesota startup called Bind Benefits, which is partnering with UnitedHealth Group — are coming up with their own novel offerings.

Insurers say the two new types of plans meet the ACA’s rules, although they interpret those rules in new ways. For example, the new policies avoid the federal law’s rule limiting consumers’ annual in-network limit on out-of-pocket costs. One policy manages that by having no network — patients are free to find providers on their own. And the other skirts the issue by calling additional charges “premiums.” Under ACA rules, premiums don’t count toward the out-of-pocket maximum.

But each plan could leave patients with huge costs in a system in which it is extremely difficult for a patient to be a smart shopper — in part because they have little negotiating power against big hospital systems and partly because the illness is often urgent and unanticipated.

If these alternative plans prompt doctors and hospitals to lower prices, “then that is worth taking a closer look,” says Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “But if it’s simply another flavor of shifting more risk to employees, I don’t think in the long term, that’s going to bend the cost curve.”

Balancing freedom, control, and responsibility

The North Carolina Blue Cross Blue Shield “My Choice” policies aim to change the way doctors and hospitals are paid by limiting reimbursement for services to 40 percent above what Medicare would pay. The plan has no specific network of doctors and hospitals.

This approach “puts you in control to see the doctor you want,” the insurer says on its website. The plan is available to individuals who buy their own insurance and to small businesses with one to 50 employees. It’s aimed at consumers who cannot afford ACA plans, says Austin Vevurka, a spokesman for the insurer. The policies are not sold on the ACA’s insurance marketplace but can be purchased off-exchange from brokers.

With that freedom, however, consumers also have the responsibility to shop around for providers who will accept that amount of reimbursement for their services. Consumers who don’t shop — or can’t because their medical need is an emergency — may get “balance-billed” by providers who are unsatisfied with the flat amount the plan pays.

“There’s an incentive to comparison-shop to find a provider who accepts the benefit,” says Vevurka.

The cost of balance bills range widely but could be thousands of dollars in the case of hospital care. Consumer exposure to balance bills is not capped by the ACA for out-of-network care.

“There are a lot of people for whom a plan like this would present financial risk,” says Levin-Scherz.

In theory, though, paying 40 percent above Medicare rates could help drive down costs over time if enough providers accept those payments. That’s because hospitals currently get about double Medicare rates through their negotiations with insurers.

“It’s a bold move,” says Mark Hall, director of the health law and policy program at Wake Forest University in North Carolina. Still, he says, it’s “not an optimal way” because patients generally don’t want to negotiate with their doctor on prices.

“But it’s an innovative way to put matters into the hands of patients as consumers,” Hall says. “Let them deal directly with providers who insist on charging more than 140 percent of Medicare.”

Blue Cross spokesman Vevurka says My Choice has telephone advisers to help patients find providers and offer tips on how to negotiate a balance bill. He would not disclose enrollment numbers for My Choice, which launched Jan. 1, nor would he say how many providers have indicated they will accept the plan’s payment levels.

Still, the idea — based on what is sometimes called “reference pricing” or “Medicare plus” — is gaining attention. Under that method, hospitals are paid a rate based on what Medicare pays, plus an additional percentage to allow them a modest profit.

North Carolina’s state treasurer, for example, hopes to put state workers into such a pricing plan by next year, offering to pay 177 percent of Medicare. The plan has ignited a firestorm of opposition from hospitals in the state.

Montana recently got its hospitals to agree to such a plan for state workers, paying 234 percent of Medicare, on average.

Partly because of concerns about balance-billing, employers aren’t rushing to buy into Medicare-plus pricing just yet, says Jeff Long, a health care actuary at Lockton Companies, a benefits consultancy.

Wider adoption, however, could spell its end.

Hospitals might agree to participate in a few such programs, but “if there’s more take up on this, I see hospitals possibly starting to fight back,” Long says.

What about the bind?

Minnesota startup Bind Benefits eliminates annual deductibles in its “on-demand” plans sold to employers that are opting to self-insure their workers’ health costs. Rather than deductibles, patients pay flat-dollar copayments for a core set of medical services, from doctor visits to prescription drugs.

In some ways, it’s simpler: There is no need to spend through the deductible before coverage kicks in or wonder what 20 percent of the cost of a doctor visit or surgery would be.

But not all services are included. Does this sound familiar? As I started this post with my examples…ladies and gentlemen, we have a problem!!

Patients who discover during the year that they need any of about 30 common procedures outlined in the plan, including several types of back surgery, knee arthroscopy or coronary artery bypass, must “add in” coverage, spread out over time in deductions from their paychecks.

“People are used to that concept, to buy what they need,” said Bind CEO Tony Miller. “When I need more, I buy more.”

According to a company spokeswoman, the add-in costs vary by market, procedure, and provider. On the lower end, the cost for tonsillectomy and adenoidectomy ranges from $900 to $3,000, while lumbar spine fusion could range from $5,000 to $10,000.

To set those additional premiums, Bind analyzes how much doctors and facilities are paid, along with some quality measures from several sources, including UnitedHealth. The add-in premiums paid by patients vary depending on whether they choose lower-cost providers or more expensive ones.

The ACA’s 2019 out-of-pocket maximums — $7,900 for an individual or $15,800 for a family — don’t include premium costs.

The Cumberland School District in Wisconsin switched from a traditional plan, which it purchased from an insurer for about $1.7 million last year, to Bind. Six months in, according to the school district’s superintendent, Barry Rose, the plan is working well.

Right off the bat, he says, the district saved about $200,000. More savings could come over the year if workers choose lower-cost alternatives for the “add-in” services.

“They can become better consumers because they can see exactly what they’re paying for care,” Rose says.

Levin-Scherz at Willis Towers says the idea behind Bind is intriguing but raises some concerns for employers.

What happens, he asks, if a worker has an add-in surgery, owes several thousand dollars, and then changes jobs before paying all the premiums for that add-in coverage? “Will the employee be sent a bill after leaving?” he wonders.

A Bind spokeswoman says the former employee would not pay the remaining premiums in that case. Instead, the employer would be stuck with the bill.

Next week back to finding a way to improve the Affordable Care Act/ Obamacare.

Here is my question for the week, with all this talk of Medicare for All what happened to Obamacare the pride of the Democratic Party and the Golden Trophy of President Obama?

This was and still is a great idea to provide health care for many/all and was designed by very smart people. The only big problem was how to pay for it and therefore how to make it sustainable, especially after removing the Individual Mandate. Why then Medicare for All with all of its own problems? Susannah Luthi wrote that the Centrist House Democrats on Wednesday launched a push to revive Obamacare stabilization talks, two hours after their progressive wing unveiled new Medicare for All legislation.

But Now Some of the Moderate Democrats revive talks to fund CSRs, reinsurance

The 101-strong New Democrat Coalition wants to fund reinsurance and cost-sharing reduction payments in a package that closely resembles the deal struck last Congress by Senate health committee leaders Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.).

That bill, known colloquially as Alexander-Murray, fell apart at the last minute following a GOP-Democratic dispute over including anti-abortion language.

“Well, we would call it Schrader-Bera-Kuster,” joked Rep. Kurt Schrader (D-Ore.), one of the co-chairs of the coalition’s healthcare task force as he referred to fellow co-chairs Reps. Ami Bera (D-Calif.) and Annie Kuster (D-N.H.).

He said the group wants to take another run at it, as this is a “different Congress, with different makeup,” and voters gave Congress a mandate to make the individual market more affordable.

To prod leadership into action, the group sent a letter urging prompt committee action to key committee leaders—Frank Pallone (D-N.J.) of Energy and Commerce, Chair Richard Neal (D-Mass.) of Ways and Means, and Bobby Scott (D-Va.) of Education and Labor.

“Building upon your work and the work of the New Democrat Coalition last Congress, we urge your committees to deliver on the promises made to our constituents by prioritizing strengthening the ACA and continuing the path toward universal affordable coverage,” the group wrote.

The group hopes numbers are on their side. It’s now the largest ideological caucus in Congress and owes its swelling ranks to the 40 Democratic freshmen who swept into office largely with the ACA on their platform.

The coalition announced its healthcare policy wish list two hours after progressive Democrats’ 70-minute press conference unveiling the new Medicare for All or single payer legislation.

Coalition members downplayed their role as opposing single payer—highlighting instead the pragmatism of lowering ACA individual market premiums as action Congress can take immediately for people who remain unsubsidized.

They also said they want to discuss public options, such as a policy to allow people to buy into Medicare or Medicaid.

Democratic leaders have pushed support for the ACA as a key part of their agenda, but proposals so far this Congress haven’t included funding for CSRs—whose cut-off led to the silver-loading that boosts premiums for people who can’t get subsidies—or reinsurance.

The Pallone-Neal-Scott proposal from last year includes reinsurance and CSRs, but enthusiasm for funding CSRs has waned since last year. Liberal advocates like the fact that the CSR cut-off led to bigger subsidies for low-income people.

And while insurers hope stabilization talks resurface, their profitability on the exchanges is soaring.

On Wednesday, Pallone told an audience at an Atlantic Live event that he’s most interested in growing the subsidies—increasing the pool of people who qualify for them and raising what’s available for people who currently receive them.

“It’s clear now that people at the higher income level, who were not eligible for those subsidies before, that we need to raise that, for people with a higher income, because there are people now making over $85, $90k a year who don’t get any subsidy,” Pallone said Wednesday morning. “In a place like New Jersey, that’s not a lot of income for a family of four.”

He also confirmed that the House will push back against the Trump administration’s expansion of short-term, limited duration plans.

Pallone was pressed on the cost problem: that an increase in subsidies puts the government on the hook for most of the high premiums, he pointed to his proposal to set up a reinsurance pool.

On whether Congress could overcome last year’s dispute over abortion language, Schrader was optimistic.

However, a Republican aide for the Senate health committee responded by referring to a comment made to Modern Healthcare last week.

“The only way Congress could pass an appropriation for CSRs is if Democrats reverse course and agree to apply the Hyde Amendment which applies to all other healthcare appropriations,” the staffer said.

Dems hit GOP on health care with additional ObamaCare lawsuit vote

At the beginning of January, Jessie Hellmann reported that in the first week of this year the House passed a resolution backing the chamber’s recent move to defend ObamaCare against a lawsuit filed by GOP states, giving Democrats another opportunity to hit Republicans on health care.

GOP Reps. Brian Fitzpatrick (Pa.), John Katko (N.Y.) and Tom Reed (N.Y.) joined with 232 Democrats to support the measure, part of Democrats’ strategy of keeping the focus on the health care law heading into 2020. The final vote tally was 235-192.

While the House voted on Friday to formally intervene in the lawsuit as part of a larger rules package, Democrats teed up Wednesday’s resolution as a standalone measure designed to put Republicans on record with their opposition to the 2010 law.

A federal judge in Texas last month ruled in favor of the GOP-led lawsuit, saying ObamaCare as a whole is invalid. The ruling, however, will not take effect while it is appealed.

Democrats framed Wednesday’s vote as proof that Republicans don’t want to safeguard protections for people with pre-existing conditions — one of the law’s most popular provisions.

“If you support coverage for pre-existing conditions, you will support this measure to try to protect it. It’s that simple,” said Rules Committee Chairman Jim McGovern (D-Mass.) before the vote.

Most Republicans opposed the resolution, arguing it was unnecessary since the House voted last week to file the motion to intervene.

“At best, this proposal is a political exercise intended to allow the majority to reiterate their position on the Affordable Care Act,” said Rep.Tom Cole (R-Okla.). “At worst, it’s an attempt to pressure the courts, but either way, there’s no real justification for doing what the majority wishes to do today.”

The Democratic-led states defending the law are going through the process of appealing a federal judge’s decision that ObamaCare is unconstitutional because it can’t stand without the individual mandate, which Congress repealed.

Democrats were laser-focused on health care and protections for people with pre-existing conditions during the midterm elections — issues they credit with helping them win back the House.

The Trump administration has declined to defend ObamaCare in the lawsuit filed by Republican-led states, which argue that the law’s protections for people with pre-existing conditions should be overturned. It’s unusual for the DOJ to not defend standing federal law.

The House Judiciary Committee, under the new leadership of Chairman Jerrold Nadler (D-N.Y.), plans to investigate why the Department of Justice decided not to defend ObamaCare in the lawsuit.

“The judiciary committee will be investigating how the administration made this blatantly political decision and hold those responsible accountable for their actions,” Nadler said.

Democrats are also putting together proposals to undo what they describe as the Trump administration’s efforts to “sabotage” the law and depress enrollment.

“We’re determined to get that case overruled, and also determined to make sure the Affordable Care Act is stabilized so that the sabotage the Trump administration is trying to inflict ends,” said Rep. Frank Pallone Jr. (D-N.J.), chairman of the Energy and Commerce Committee, which has jurisdiction over ObamaCare.

One of the committee’s first hearings this year will focus on the impacts of the lawsuit. The hearing is expected to take place this month.

The Ways and Means Committee, under the leadership of Chairman Richard Neal (D-Mass), will also hold hearings on the lawsuit and on protections for people with pre-existing conditions.

Those two committees, along with the Education and Labor Committee, are working on legislation that would shore up ObamaCare by increasing eligibility for subsidies, blocking non-ObamaCare plans expanded by the administration and increasing outreach for open enrollment.

And Now the House Democrats Decry ‘Junk Plans’ and are introducing bills to reverse Trump-inflicted ACA “sabotage”

Shannon Firth noted that the Democrats blasted attempts by the Trump administration to “sabotage” the Affordable Care Act during a House Energy & Commerce Health Subcommittee hearing on Wednesday.

“We’re inviting people back into a world with mirrors and trap doors, which was exactly the place we wanted to get away from when we passed the ACA,” said Rep. John Sarbanes (D-Md.), who called on his colleagues to “push back against these junk plans.”

House Democrats introduced four bills to roll back administration efforts to loosen or circumvent the ACA’s insurance requirements. In the very unlikely event that they pass the Republican-controlled Senate and gain the president’s signature, they would:

Require all short-term health plans to include a warning explicitly stating which benefits are included and which aren’t

Restore marketing and outreach funding for ACA exchanges

Rescind a regulation that extended the allowable duration of short-term plans (including renewals) to just under 3 years

Cancel the administration’s new guidance around 1332 waivers, which relaxed certain “guard rails”

Republicans complained that ACA plans are unaffordable for middle-income Americans who don’t receive subsidies, and argued that the Trump administration’s actions allow those same Americans more options for cheaper health plans.

“They’re really trying to give consumers new options, particularly those who were shut out of the market because of costs,” said Grace-Marie Turner, a witness at the hearing and president of the Galen Institute, a conservative think tank, in defense of the administration.

Republicans also pushed back on criticism of the administration’s 1332 waiver guidance, saying Democrats were denying states the right to innovate their programs and instead of trying to impose the will of Washington.

Turner stressed that states are better positioned to regulate their own local health insurance markets.

Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said that none of the bills being discussed would increase the availability of “reasonably priced plans.”

Are Short-Term Plans Junk?

Much of Wednesday’s discussion focused on short-term plans, which are cheaper than ACA exchange plans but offer a shrunken set of benefits.

In August, the Trump administration issued a final rule extending the duration of these plans for just under 12 months and made plans eligible for renewals for nearly 3 years. Previously, the plans were available for just under 3 months at a maximum.

Rep. Kathy Castor (D-Fla.), who introduced a bill to rescind the short-term plan rule, said she’s worried “the public is being snookered here.”

“Maybe you were healthy when you signed up. Then, something happens — you have a big medical claim. It triggers an alarm and [the insurers] go back and look at your application, and pull all your medical records again and go, ‘Oh, you should have told us about this,'” she told MedPage Today after the hearing.

Even in cases where a patient was not diagnosed with an illness prior to enrollment, insurers find ways to justify cancellation, she said.

Rep. Nanette Barragán (D-Calif.) offered one example, a Chicago businessman who was encouraged to buy a short-term plan by a broker even after disclosing symptoms of serious back pain. After he enrolled, the businessman was diagnosed with non-Hodgkin lymphoma. Insurers then reviewed his medical records and determined that the businessman’s cancer was a pre-existing condition because he had visited a chiropractor in the past, leaving him with over $800,000 in medical bills after 6 months, Barragán said.

“You would never expect your cancer treatment to be denied because you’ve had bad back pain,” Keith said. “That’s something that, I think, disclosures can’t fix.”

Jessica Altman, Pennsylvania Insurance Department commissioner, pointed out that short-term plans may not cover ACA-defined “essential health benefits.” She cited a study showing that less than 60% cover mental health, only about one-third cover treatment for substance use disorder or prescription drugs, and none included maternity benefits.

Altman also noted that short-term plans aren’t required to abide by the ACA’s medical loss ratio requirements. The two largest short-term plan vendors, which control 80% of the market, spend less than half of each premium dollar on “actual medical care,” she said.

But Turner said short-term plans are meant to serve as “bridge plans” for individuals such as early retirees, people in the gig economy, and young entrepreneurs starting a business, who would convert before long to more comprehensive coverage. Turner also emphasized the plans’ affordability — with premiums less than half of what an ACA plan would cost — and stressed that consumers understand the plans aren’t permanent.

Rep. Richard Hudson (R-N.C.) pointed out that states are allowed to impose limits on short-term plans or ban them altogether.

“I think it’s important to note that we’re not forcing anyone into this. We’re giving flexibility to the states,” he said.

He suggested bringing in witnesses from states where plans are available to learn their true impact.

New Waiver Guidance

Another bill, explored at the hearing, would revoke the administration’s changes to 1332 waivers, which loosened standards for what qualifies as healthcare coverage. The administration’s waiver also allows ACA subsidies to be spent on short-term plans.

Rep. Frank Pallone (D-N.J.), who chairs the full Energy & Commerce Committee, said the changes “turn the statute on its head,” exceeding the administration’s authority and “contrary to congressional intent.”

Keith agreed. She said the guidance was inconsistent with the statute itself. Instead of improving access to healthcare, the guidance “undermines” it. In particular, subsidizing short-term health plans “flies in the face of 1332,” she said.

Several Republicans, including Rep. Greg Walden (R-Ore.), ranking member for the full committee, highlighted the successful implementation of reinsurance programs in states such as Alaska, Minnesota, Oregon, and others, claiming that Democrats oppose state innovation.

Keith clarified that the reinsurance programs were approved under the 1332 rules as written by the previous administration, without the Trump administration’s changes.

Any waivers approved under the Trump administration’s new guidance would likely trigger a lawsuit, she said. As for short-term health plans, several patient advocacy groups have already filed a lawsuit targeting the administration’s new guidance for those plans.

So, I am not going to pursue this issue anymore because I want all of us to consider my first question-Why are Bernie Saunders and most of the multiple Democrat candidates running for President in 2020 touting Medicare for All instead of coming up with fixes for the Affordable Care Act/ Obamacare?

Let us discuss possible fixes to Obamacare next week.

And to a lighter side:

You can now buy an actual hospital room on Amazon

Amazon is increasingly moving into the business of selling supplies to hospitals.

Now, that includes “smart” hospital rooms that can be purchased on its marketplace as of Thursday.

The units are targeted to hospitals and are made by a company called EIR Healthcare.

MedModular

You can buy almost everything on Amazon. And that includes, as of Thursday, a “smart” hospital room in a box.

A New York-based company called EIR Healthcare is now selling units of its hospital room, dubbed MedModular, for $814 a square foot on Amazon.com, which the company claims are more affordable than traditional construction. The design is customizable but all the rooms come with a bathroom and a bed.

These rooms don’t come cheap at $285,000 per unit, but they are targeted to business buyers that are increasingly flocking to Amazon.

So who would buy the units?

“We’re targeting hospitals and health systems,” said Grant Geiger, CEO of EIR Healthcare, the company selling the units. “There’s a trend towards bringing more transparency in the health care space,” he added.

Geiger said he’s currently seeing an uptick in interest from hospitals in using the units for things like simulation labs, or urgent care facilities.

Geiger has also considered looking into potential customers in the military.

But hospital administrators are an obvious place to start, he said, as Amazon is already selling them medical supplies ranging from bedpans to syringes. Previously, large hospital systems would buy everything through group purchasing organizations, or GPOs, which provided discounts but also a lack of transparency around costs.

MedModular

Now, Amazon is looking to carve out its own slice of that lucrative business with its own growing portfolio of medical supplies.

Geiger said he talked to that group for months before he got permission to sell his units on Amazon’s marketplace. He also needed the company’s approval to ship and deliver the product, which involves transporting the units in giant shipping containers down the freeway.

I don’t know whether you all remember my last few sentences of last week’s post but I was so encouraged this week because it seems that maybe some of the politicians are reading my blog (yeah right!?!?) or they recognize the severity of the measles problem today. So, I want to continue the discussion starting with a number of States who get the message.

Patti Neighmond wrote that all U.S. states require most parents to vaccinate their children against some preventable diseases, including measles, mumps, rubella, and whooping cough, to be able to attend school. Such laws often apply to children in private schools and day care facilities as well as public schools.

At the same time, beyond medical exemptions, most states also allow parents to opt out of this vaccination requirement for religious reasons. And 17 states permit other exemptions — allowing families to opt out of school vaccination requirements for personal or philosophical reasons.

Michelle Mello, a professor of law and health research and policy at Stanford University, says the bar for claiming an exemption from vaccine requirements has been very low in many states. “You can believe that vaccines don’t work or that they are unsafe or they simply fly in the face of your parenting philosophy,” she says.

But this winter’s outbreaks of measles across the nation are resulting in challenges to many exemptions: At least eight states, including some that have experienced measles outbreaks this year, want to remove personal exemptions for the measles vaccine. And some states would remove the exemption for all vaccines.

Most of this year’s measles cases have been among children who were not vaccinated against the virus.

Once considered eradicated in the U.S., measles has sickened at least 159 people since the start of 2019, according to the Centers for Disease Control and Prevention, in outbreaks ranging from Washington and Oregon to Texas and New York. Last year, there were 372 reported cases of measles nationwide.

The move among state legislatures to tighten vaccine requirements is good news to Diane Peterson, the associate director for immunization projects with the pro-vaccine advocacy group Immunization Action Coalition.

“Measles is not like a common cold,” Peterson says. “Children get very, very sick and can be hospitalized,” she says, adding that measles can even lead to death.

The virus is highly contagious, airborne and easily spreads. It can survive in the air for a couple of hours.

“A patient with measles can go to the doctor, cough in the exam room and two hours later another patient coming into the same exam room can be infected,” Peterson says.

The virus is spreading fast this winter, she says, because of the “pockets of children who have not been vaccinated, mostly due to parents who have decided not to vaccinate them.”

This leaves not only those unvaccinated school children vulnerable to the virus but also many adults who have suppressed immune systems and infants who are not old enough to be vaccinated.

According to the Association of State and Territorial Health Officials, bills to restrict exemptions are now pending in a growing number of states.

None of this sits well with activists who want their states to maintain personal and philosophical exemptions.

“Nobody should sit in judgment of another person’s religious and spiritual beliefs,” says Barbara Loe Fisher, a spokesperson for the National Vaccine Information Center, a group that lobbies against mandatory vaccination and thinks parents should have a choice. “No person should be allowed to force someone to violate their conscience when they’re making a decision about the use of a pharmacological product that carries a risk of harm.”

The scientific consensus about any risk from vaccines is that serious side effects are extremely rare. A suggestion that immunization might be tied to severe consequences like autism was debunked years ago after findings supporting that link were proved fraudulent.

Mello, the Stanford law professor who has been following the exemption debate, notes that the courts have repeatedly held that when a public health intervention is necessary to safeguard the public, individuals generally can be required to give up some personal liberty, particularly if that liberty is tied to a government benefit like school.

So far, only three states — Mississippi, West Virginia and California — prohibit nearly all vaccine exemptions, including the one exempting families who say their religious belief conflicts with vaccination. (All states allow medical exemptions when, for example, a child has a compromised immune system.)

The California state Legislature made that decision in 2015, less than a year after the state experienced a significant measles outbreak that got its first foothold among unvaccinated children visiting Disneyland.

A measles outbreak in the US has triggered debate on the ease with which parents can opt out of mandatory vaccine rules.

I noted last week that a total of 159 people have come down with the disease in 10 states since January, but one small area, in particular, Clark County in Washington State, has illustrated the dangers of these exemptions, which are sought for religious, personal or philosophical reasons.

Just north of Portland, Oregon, Clark County accounts for 65 measles cases, 47 of them among children under age 10. In almost all 65 cases, patients had not been vaccinated.

Fifteen years ago, 96 percent of school children aged five in Clark County got measles shots. But in 2017-2018, the proportion was down to 84 percent.

In some schools, mainly private ones, the rate of use of the so-called MMR vaccination against measles, mumps, and rubella was only 20 to 30 percent. In some of the schools, more than half the students had received exemptions.

Local lawmakers in Washington State have responded to the outbreak by advancing legislation that would do away with exemptions on personal or philosophical grounds. Opt-outs for religious reasons would still be allowed.

Such exemptions are widely available in the United States. Only three of the 50 states—California, Mississippi, and Virginia do not allow them.

California did away with exemptions for personal reasons in 2015. In the most populous US state, exemptions are permitted only for medical reasons.

In recent years other states have toughened their laws. Connecticut, for instance, requires parents claiming an exemption for religious reasons to provide a yearly, notarized statement to this effect. Since 2015, Delaware has allowed schools to temporarily exclude non-vaccinated kids.

Vermont wants to get rid of religious exemptions, after eliminating those sought for philosophical reasons four years ago, according to The Washington Post. Arizona, Iowa, Minnesota are also debating stricter laws.

Congressional hearing

The US Congress will hold a hearing Wednesday on the issue of vaccinating children.

Overall, the vaccination rate of kids in the US has remained stable, according to the Centers for Disease Control and Prevention, which monitors such trends closely.

It reports that in the 2017-2018 school year, around 95% of American kindergarteners were vaccinated against MMR, chicken pox and diphtheria, tetanus and whooping cough.

But the national rate masks wide disparities from state to state and even from one school to the next, as the case of Clark County illustrates.

And health authorities are alarmed because the previous school year was the third in a row in which requests for exemptions from vaccination increased, even though the rises were small.

And the proportion of kids reaching age two without having received any kind of vaccination is also growing, albeit slowly: 0.9 percent of children born in 2011 to 1.3 percent among those born in 2015. Vaccination-free kids were practically unheard of at the turn of the century.

Exemptions alone do not explain why children are not vaccinated. Many vaccines are recommended for American children in their first two years of life—the CDC advises they be used for 14 diseases—and this is hard for parents to keep up with, especially for vaccines that require three or four shots.

Another problem is access to health insurance. Children in families without such insurance make up a disproportionate amount of those who go without shots, according to the CDC.

In Congress, the measles outbreak has prompted lawmakers to act.

The disease routinely infected American kids before a vaccine was introduced in 1963. Before that, it killed 400 to 500 people a year in the US. In 2000 it was declared eliminated. But since then, over the years anywhere from 50 to 600 cases have been reported annually.

Two US senators recently called on the CDC to explain what it is doing in response to what they called “pockets of unvaccinated people.”

‘We Need to Get to Zero’ on Measles: NIAID Chief to House Panel

I think we all agree and members from both parties express support for measles, mumps, and rubella vaccine

Our friend Joyce Frieden, the News Editor of MedPage Today, reported that the views that some House committee members expressed Wednesday in favor of vaccination brought to mind a line from a character on a British television show: “I am unanimous in this.”

“It wasn’t until the development of the MMR [measles, mumps, and rubella] vaccine that we as a country were able to stop this horrific illness,” said Rep. Diana DeGette (D-Colo.), chairman of the House Energy & Commerce Subcommittee on Oversight and Investigations, at a hearing on recent measles outbreaks in the U.S. “But despite that success, here we are again 20 years later.”

Rep. Greg Walden (R-Ore.), a ranking member of the full Energy & Commerce Committee, noted that one in four people diagnosed with measles will end up being hospitalized. “If we don’t reverse the downward trend in vaccination, we risk bringing back measles in full force,” he said.

DeGette called the recent measles outbreaks “a real cause for national concern” and pointed out that the national measles vaccination rate for children stands at 91%.

“That may seem high to some, but it’s well below the 95% vaccination rate required to protect communities and give them herd immunity,” she said. “And while the overall national rate of MMR vaccines is currently at 91%, the rate in some communities is much lower — some as low as 77%. Outbreaks like the one we’re seeing with measles remind us of just how interconnected our communities are … As a nation, to stop the spread of deadly diseases, we have to address the root cause of the problem and we have to define concrete steps … We need to support additional research into vaccine safety to further increase consumer confidence in these vaccines.”

Nearly 160 Cases This Year

Once again the numbers are important and so from Jan. 1, 2019 to Feb. 21, 2019, there have been 159 confirmed measles cases in 10 states, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told the committee. The states reporting outbreaks include California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. In 2018, 372 people in 25 states and the District of Columbia were reported to have measles; most of those cases involved unvaccinated people, she added.

Although measles was officially eliminated in the U.S. in 2000, and the rate of measles vaccination coverage is fairly high nation-wide, “there are pockets of people who are vaccine hesitant who delay or even refuse to vaccinate themselves and their children,” which can cause outbreaks, Messonnier said. Many of those live in close-knit communities where they share the same religious beliefs or ethnic backgrounds as their neighbors. Others simply have a strong personal belief against vaccination.

“In the past 5 years, there have been 26 measles outbreaks of more than five cases, 12 of which were in close-knit communities, including a Somali community in Minnesota in 2017 and Orthodox Jewish communities in New York City and New York state in 2018; these 12 outbreaks account for over 75% of cases in the past 5 years,” she said, adding that “Vaccine hesitancy is the result of a misunderstanding of the risk and seriousness of disease combined with misinformation regarding the safety and effectiveness of vaccines. However, the specific issues fueling hesitancy vary by community” and must be attacked locally with the help of the CDC.

The federal government’s Vaccines for Children (VFC) program is a “critical component” of the fight against vaccine-preventable diseases, Messonnier said. “Because of VFC, we have seen significant decreases in disparities in vaccination coverage … For each dollar invested [in the program], there are $10 of societal savings and $3 in direct medical savings.”

‘I Am a Measles Survivor’

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, said that measles was “one of the most contagious pathogens we know of” and explained that since the virus has been well sequenced, “we can tell, when the virus is reintroduced into our country, from where it comes.” For example, researchers were able to determine that a measles virus that led to an outbreak among a community of Hasidic Jews in Brooklyn in New York City came from Israel.

“I consider it really an irony that you have one of the most contagious viruses known to man, juxtaposed against one of the most effective vaccines that we have, and yet we don’t do and have not done what could be done — namely, completely eliminate and eradicate this virus.” Fauci showed a slide delineating the recent outbreaks. “This slide is really unacceptable; this is a totally vaccine-preventable disease … What we all should strive for, that measles in the United States, we need to get to zero.”

A few hearing participants shared their own experience with the disease. “I am a measles survivor,” said Rep. Michael Burgess, MD (R-Texas). “I was at an age where the measles vaccine was not available. Even though I was very young when that happened, I still remember … the heart-shaking chills, the muscle pain, and the rash that’s [emblematic] of measles.” Fauci said he also had the disease and that it was “very uncomfortable and very scary.” Rep. Brett Guthrie (R-Ky.), the subcommittee’s ranking member said that one of his close childhood friends “was essentially born without a hand” after the friend’s mother contracted rubella during her pregnancy. “I’ve always thought of measles and how devastating it can be.”

Guthrie also asked Fauci whether people could “self-medicate” with vitamin A to prevent measles. Fauci responded that children with vitamin A deficiency who get measles “have a much more difficult course, so vitamin A [supplements] can actually protect you from some of the toxic and adverse effects,” but that doesn’t apply in developed countries where such deficiencies are rare. “It doesn’t prevent measles, but it’s important in preventing complications in societies in which vitamin A deficiency might exist,” he said.

The Thimerosal Question

Burgess asked about whether thimerosal — a mercury-containing preservative often mistakenly claimed to cause problems with vaccines — was in the measles vaccine. “No, it’s preservative-free,” said Fauci. Burgess asked whether there was ever any evidence that mercury or thimerosal was unsafe. Messonnier said thimerosal had been removed from vaccines “out of an abundance of caution at a time when there wasn’t enough evidence, but evidence since then has been very conclusive” that thimerosal is safe.

The hearing was also marked by a few disruptions, including some shouts from the audience when Fauci, responding to a question, said that the measles vaccine couldn’t cause encephalitis. DeGette told the audience that such disruptions were in violation of House rules; Messonnier then said that the vaccine doesn’t cause brain swelling or encephalitis in healthy children.

Guthrie remarked that whether or not parents choose to vaccinate their children, they do so with the best of intentions. “Whatever decisions they’re making, they’re making it in the love and best interest of their child,” he said. “So I think it’s important we do have the science … and people with credentials and reputations to present this evidence, and hopefully people have the opportunity to see it and read it.”

Measles cases soar worldwide, UN warns of ‘complacency’

Outside of the U.S., I think it is necessary to see how this disease is affecting other countries. I brought up the statistics regarding the incidence and the deaths in the Philippines but on a broader scale Cynthia Goldsmith reviewed the statistics with regard of the measles problem in the world and noted that just 10 countries were responsible for three-quarters of a global surge in measles cases last year, the UN children’s agency said Friday, including one of the world’s richest nations, France.

Ninety-eight countries reported more cases of measles in 2018 compared with 2017, and the world body warned that conflict, complacency and the growing anti-vaccine movement threatened to undo decades of work to tame the disease.

“This is a wakeup call. We have a safe, effective and inexpensive vaccine against a highly contagious disease—a vaccine that saved almost a million lives every year over the last two decades,” said Henrietta Fore, executive director of UNICEF.

“These cases haven’t happened overnight. Just as the serious outbreaks we are seeing today took hold in 2018, lack of action today will have disastrous consequences for children tomorrow.”

Measles is more contagious than tuberculosis or Ebola, yet it is eminently preventable with a vaccine that costs pennies.

But the World Health Organization last year said cases worldwide had soared nearly 50 percent in 2018, killing around 136,000 people.

Ukraine, the Philippines, and Brazil saw the largest year-on-year increases. In Ukraine alone, there were 35,120 cases—nearly 30,000 more than in 2017.

Brazil saw 10,262 cases in 2018 after having none at all the year before, while the Philippines reported 15,599 cases last year compared to 2,407 in 2017.

Taken together, the ten nations accounting for 75 percent of the increase from 2017 to 2018 account for only a tenth of the global population.

The countries with the highest rate of measles last year were Ukraine (822 cases per million people), Serbia (618), Albania (481), Liberia (412), Georgia (398), Yemen 328), Montenegro (323) and Greece (227).

While most of the countries that experienced large spikes in cases are beset by unrest or conflict, France saw its caseload jump by 2,269.

In the United States, there was a 559 percent year-on-year increase in cases from 120 to 791.

Misinformation and mistrust

The resurgence of the disease in some countries has been linked to medically baseless claims linking the measles vaccine to autism, which have been spread in part on social media by members of the so-called “anti-vax” movement.

The WHO last month listed “vaccine hesitancy” among the top 10 most pressing global health threats for 2019.

“Almost all of these cases are preventable and yet children are getting infected even in places where there is simply no excuse,” Fore said.

“Measles may be the disease, but all too often the real infection is misinformation, mistrust and complacency.”

In war-torn Yemen, where health services in many regions have collapsed, UNICEF and the World Health Organization joined with local authorities last month in a campaign to vaccinate some 13 children aged six months to 15 for measles and rubella.

UN officials estimated that 92 percent of the targeted children were jabbed during the one-week push, which ended on February 14.

Yemen also figured on UNICEF’s “top 10” list of countries showing the largest increases last year in measles cases with a 316 percent hike, from 2,101 cases in 2017 to 8,742 cases in 2018.

Other countries with huge jumps last year compared to 2017 are Venezuela (4,916 more cases, up 676 percent), Serbia (4,355 more cases, up 620 percent), Madagascar (4,307 more cases, up 5,127 percent), Sudan (3,496 more cases, up 526 percent) and Thailand (2,758 more cases, up 136 percent).

A few countries saw declines in the number of confirmed cases of measles.

In Romania, reported cases dropped 89 percent from 8,673 to 943, and in Indonesia, the number declined by 65 percent from 11,389 to 3,995.

Nigeria, Pakistan, Italy, and China also saw drops of 35 to 55 percent.

So, the number of worldwide resurgence of cases of measles is huge and we as a community need to step up and push our healthcare community and the government to step up and demand that we protect our youth both here in the U.S.A. and yes, in the world. Also, we need to ignore the politics and the misinformation and mistrust and get the job done for our kids, and future generations!

I had to discuss this topic again due to the recent deaths of children who haven’t been vaccinated. It struck a nerve because back, when a friend of mine’s daughter was pregnant, before delivery of our their granddaughter, her future pediatrician, and ObGyn, told her and her husband that all people who came in contact with their future baby should be vaccinated for pertussis, diphtheria etc. Her in-laws said that they were against vaccinations. Their daughter was crushed and she called her father in tears. What to do and what to suggest to their family?

Simple, my suggestion was to tell his daughter to tell the family or have her husband tell his family that if they wanted to visit and see their future niece and granddaughter they needed to be vaccinated or just don’t visit and get a hotel room and then they could see the baby through the glass front door or through the windows. It is about the baby and not about them!

So, when I read the next two articles with the deaths due to measles I was enraged. Parents who are the anti-vaxers, it is about the children and not about their idiot beliefs formed by non-data and from a British physician who had his license taken away.

Dennis Thompson, a HealthDay reporter reported that Measles outbreaks across the United States—including one in Washington state where 50 cases have now been identified—have again shone the spotlight on parents who resist getting kids vaccinated.

These outbreaks are a clear sign of the fraying of “herd immunity,” the overall protection found when a large majority of a population has become immune to a disease, said Dr. Paul Offit. He is director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

“Measles is the most contagious of the vaccine-preventable diseases, so it’s always the first to come back when you see a drop in herd immunity,” Offit said.

The World Health Organization has taken notice, and recently declared the anti-vaxxer movement a major threat to public health.

Given this, why does anti-vaccine sentiment continue to thrive in certain locales throughout America?

Offit suspects it’s because people have forgotten just how bad diseases like measles, chickenpox and whooping cough can be.

“It’s happening because people aren’t scared of the diseases,” Offit said. “I think vaccines in some ways are victims of their own success.”

But other factors come into play, including a reluctance to give a slew of vaccines to a young child so early in life, now-debunked fears of a link to autism, a feeling that diseases are a natural part of childhood, and a deep-seated distrust of the medical community.

Measles outbreaks were “inevitable,” said Dr. Dawn Nolt, an associate professor of pediatric infectious disease at OHSU Doernbecher Children’s Hospital in Portland, Ore. She lives close to the Washington border, where the biggest current measles outbreaks rage.

“Pockets of communities where there are low vaccine rates are ripe to be ground zero for an outbreak,” Nolt said. “All you need is one person in that community. We knew this was going to happen.”

That’s particularly true of measles, which is incredibly virulent.

Offit explained “you don’t have to have face-to-face contact with someone who has measles. You just have to be within their air space within two hours of their being there.”

According to Nolt, despite its power to spread, there are three questions that typically come up with parents who are hesitant about having their children vaccinated against measles: Is the vaccine safe? Is the vaccine needed? Why shouldn’t I have freedom of choice regarding my child’s vaccinations?

“I think what’s important is to really understand that families have certain concerns and we need to understand those concerns,” Nolt said. “We can’t lump them all together and think that that one conversation serves all of their concerns.”

Parents’ concerns regarding vaccination are often first sparked by the recommended vaccine schedule, Offit said.

“What’s happened is we ask parents of young children in this country to get vaccines to prevent 14 different diseases,” Offit said. “That can mean as many as 26 inoculations during those first few years of life, as many as five shots at one time, to prevent diseases most people don’t see, using biological fluids most people don’t understand.”

So, it’s important that doctors explain to parents that these vaccines are “literally a drop in the ocean” compared to the myriad immune system triggers a child encounters each day, Offit said.

“Very quickly after birth, you have, living on the surface of your body, trillions of bacteria, to which you make an immune response,” Offit explained. “The food you eat isn’t sterile. The dust you inhale isn’t sterile. The water you drink isn’t sterile. You’re constantly being exposed to bacteria to which you make an immune response.”

Doctors also still have to deal with an erroneous 1998 study that linked vaccinations and autism, said Dr. Talia Swartz, an assistant professor of infectious diseases with the Icahn School of Medicine at Mount Sinai, in New York City.

The study was later found to be fraudulent and withdrawn, but “significant press has continued to raise concern about this, even though these concerns have been refuted based on large-scale population studies,” Swartz said.

It’s important to emphasize that these vaccines are heavily tested for safety, said Lori Freeman, CEO of the National Association of County and City Health Officials.

As to whether vaccines are needed, outbreaks provide a powerful argument in favor of that premise, experts said.

However, some parents still greet outbreaks with a shrug.

Nolt said that “some people think vaccines aren’t needed because the disease is more ‘natural’ than the vaccine.”

And arguments based on altruism—vaccinating your child to protect the rest of the community, especially kids who can’t be vaccinated—only go so far, she added.

“I think that resonates with people who have close family or friends who are immunocompromised. For someone who hasn’t had that experience, I think that’s a harder sell,” Nolt said.

Offit is also pessimistic that outbreaks alone will convince hesitant parents to have their kids vaccinated.

“I think children are going to have to die [for attitudes to change],” Offit said. “In regards to measles, you’re probably going to have to get 1,000 to 2,000 cases a year to start to see measles deaths again, but that can happen. Before there was a measles vaccine, which came into the United States in 1963, every year you’d see about 500 children die of measles.”

The “freedom of choice” argument can be the most difficult for doctors to counter, Nolt said. Accumulated distrust of organized medicine, federal regulators and pharmaceutical companies isn’t something a pediatrician can easily counter through conversation.

Now, look at the measles problem in the Philippines!

The Philippines says 136 people have died in a measles outbreak

The Philippine health secretary said Monday that 136 people, mostly children, have died of measles and 8,400 others have fallen ill in an outbreak blamed partly on vaccination fears.

A massive immunization drive that started last week in hard-hit Manila and four provincial regions may contain the outbreak by April, Health Secretary Francisco Duque III said. President Rodrigo Duterte warned in a TV message Friday of fatal complications and urged children to be immunized.

“No ifs, no buts, no conditions, you just have to bring your children and trust that the vaccines … will save your children,” Duque said by telephone. “That’s the absolute answer to this outbreak.”

Infections spiked by more than 1,000 percent in metropolitan Manila, the densely packed capital of more than 12 million people, in January compared to last year, health officials said.

About half of the 136 who died were children aged 1 to 4 and many of those who perished were not inoculated, the officials said.

Duque said a government information drive was helping restore public trust in the government’s immunization program, which was marred in 2017 by controversy over an anti-dengue vaccine made by French drugmaker Sanofi Pasteur which some officials linked to the deaths of at least three children.

The Philippine government halted the anti-dengue immunization drive after Sanofi said a study showed the vaccine may increase the risks of severe dengue infections. More than 830,000 children were injected with the Dengvaxia vaccine under the campaign, which was launched in 2016 under then-President Benigno Aquino III. The campaign continued under Duterte until it was stopped in 2017.

Sanofi officials told Philippine congressional hearings that the Dengvaxia vaccine was safe and effective and would reduce dengue infections if the vaccination drive continued.

“It seems the faith has come back,” Duque said of public trust on the government’s immunization drive, citing the inoculation of about 130,000 of 450,000 people targeted for anti-measles vaccinations in metropolitan Manila in just a week.

Measles is a highly contagious respiratory disease caused by a virus which can be spread through sneezing, coughing and close personal contact.

Complications include diarrhea, ear infections, pneumonia, and encephalitis, or the swelling of the brain, which may lead to death, according to the Department of Health.

A Parent-To-Parent Campaign To Get Vaccine Rates Up

Alex Olgin noted that in 2017, Kim Nelson had just moved her family back to her hometown in South Carolina. Boxes were still scattered around the apartment, and while her two young daughters played, Nelson scrolled through a newspaper article on her phone. It said religious exemptions for vaccines had jumped nearly 70 percent in recent years in the Greenville area — the part of the state she had just moved to.

She remembers yelling to her husband in the other room, “David, you have to get in here! I can’t believe this.”

Up until that point, Nelson hadn’t run into mom friends who didn’t vaccinate.

“It was really eye-opening that this was a big problem,” she says.

Nelson’s dad is a doctor; she had her immunizations, and so did her kids. But this news scared her. She knew that infants were vulnerable — they can’t get started on most vaccines until they are 2 months old. And some kids and adults have diseases that make them unable to get vaccines, so they rely on herd immunity.

Nelson was thinking about public health a lot back then and was even considering a career switch from banking to public health. She decided she had to do something.

“I very much believe if you have the ability to advocate, then you have to,” she says. “The onus is on us if we want to change.”

Like a lot of moms, Nelson had spent hours online. She knew how easy it is to fall down internet rabbit holes and into a world of fake studies and scary stories.

“As somebody who just cannot stand wrong things being on the internet,” Nelson says, “if I saw something with vaccines, I was very quick to chime in ‘That’s not true’ or ‘No, that’s not how that works.’ … I usually get banned.”

Nelson started her own group, South Carolina Parents for Vaccines. She began posting scientific articles online. She started responding to private messages from concerned parents with specific questions. She also found that positive reinforcement was important and would roam around the mom groups, sprinkling affirmations.

Peer-focused groups around the country doing similar work inspired Nelson. Groups with national reach like Voices for Vaccines and regional groups like Vax Northwest in Washington state take a similar approach, encouraging parents to get educated and share facts about vaccines with other parents.

Nationally, 91 percent of children ages 19 to 35 months old have their vaccination for measles, and rates for other vaccinations range from 82 to 92 percent. But in some communities, the rate is much lower. In Clark County, Wash., where a measles outbreak is up to 63 cases, about 76 percent of kindergartners come to school without all their vaccines.

Public health specialists are raising concerns about the need to improve vaccination rates. But efforts to reach vaccine-hesitant parents often fail. When presented with As reported by facts about vaccine safety, parents often remained entrenched in a decision not to vaccinate.

Pediatricians could play a role — and many do — but they’re not compensated to have lengthy discussions with parents, and some of them find it a frustrating task. That has left an opening for alternative approaches, like Nelson’s.

Nelson thought it would be best to zero in on moms who were still on the fence about vaccines.

“It’s easier to pull a hesitant parent over than it is somebody who is firmly anti-vax,” Nelson says. She explains that parents who oppose vaccination often feel so strongly about it that they won’t engage in a discussion. “They feel validated by that choice — it’s part of a community, it’s part of their identity.”

The most important thing is timing: People may need information about vaccines before they become parents. A first pregnancy — when men and women start transitioning into their parental roles — is often when the issue first crops up. Nelson points to one survey study from the Centers for Disease Control and Prevention that showed 90 percent of expectant women had made up their minds on vaccines by the time they were six months pregnant.

“They’re not going to a pediatrician [yet],” Nelson says. “Their OB-GYN is probably not speaking to the pediatric vaccine schedule. … So where are they going? They are going online.”

Nelson tries to counter bad information online with facts. But she also understands the value of in-person dialogue. She organized a class at a public library and advertised the event on mom forums. Nelson was nervous that people opposed to vaccines, whom she calls “anti-vaxxers,” might show up and cause a scene. Vaccine opponents had already banned her from some online forums.

“Are they here to rip me a new one? Or are they here to learn about vaccines?” Nelson wondered. “I just decided, if they’re here I’m going to give them good information.”

Amy Morris was pregnant, but she drove an hour and a half to attend the class. Morris wasn’t the typical first-time mom Nelson was trying to reach. She already had three kids. But during this pregnancy, she was getting increasingly nervous about vaccines. She had recently had a miscarriage, and it was right around the time she had gotten a flu shot. Morris had been reading pro- and anti-vaccine posts in the mom forums and was starting to have some doubts. In Nelson’s class, she learned the risks of not vaccinating.

“That spoke to me more than anything,” said Morris.

Now, holding her healthy 8-month-old son, Thorin, on her lap, she says she’s glad she went because she was feeling vulnerable.

“I always knew it was the right thing to do,” Morris said. “I was listening to that fear monster in the back of my head.”

Nelson says that fear is what the anti-vaccine community feeds on. She has learned to ask questions to help parents get at the root of their anxiety.

“I do think they appreciate it when you meet them sympathetically and you don’t just try and blast facts down their throat,” Nelson said.

Nelson is now trying to get local hospitals to integrate that vaccine talk into their birthing classes. She’s studying for a master’s degree in public health at the University of South Carolina and also works with the Bradshaw Institute for Community Child Health & Advocacy. She’s even considering a run for public office.

House lawmakers to investigate measles outbreak

As reported by our old friend Susannah Luthi, now Congress is wading into the debate over the controversial “philosophical exemption” to immunization, with a key House committee investigation into the recent measles outbreaks that have hit at least 67 people across four states.

The House Energy and Commerce Committee’s oversight panel will hold a bipartisan hearing on the outbreak and response efforts next Wednesday, Feb. 27.

Committee Chair Frank Pallone (D-N.J.) and ranking member Greg Walden (R-Ore.) joined oversight panel Chair Diana DeGette (D-Colo.) and ranking member Brett Guthrie (R-Ky.) in a statement that warned the influx of vaccine-preventable diseases is a serious public health threat.

“Measles is a highly contagious, life-threatening virus that was previously eliminated in the United States thanks to the success of the measles vaccine,” the lawmakers wrote. “Unfortunately, measles cases are on the rise as a consequence of the virus’s transmission among unvaccinated groups.”

The conversation around vaccinations has been escalating inside the Beltway in recent weeks after an initial batch of more than 40 cases of measles was reported in Oregon and Washington state.

In late January, Washington Democratic Gov. Jay Inslee declared a state of emergency due to the outbreak.

Vaccines had eliminated the virus in the U.S. by 2000, but it can return with overseas travelers and spread among the unvaccinated.

Food and Drug Administration Commissioner Dr. Scott Gottlieb has been vocal on Twitter about the public health threat, urging immunizations and suggested to Axios last week that the federal government may have to step in.

In a Tuesday interview on CNN, he elaborated further, warning that if “certain states continue down the path that they’re on, I think they’re going to force the hand of the federal health agencies.”

I believe that the only reason for not vaccinating children should be allergies to a component of the vaccine. We can’t lose any more children to ignorant parents and or incorrect data regarding complications of the vaccines.

So, even if we gave the Democrats everything that they want, where everything including education, money for not working, and of course free health care for all would that solve this problem? I think not!!

It was an interesting week on so many levels. I guess that we don’t have to worry about another government shut down…. until next September but now Congress, the Senate and the President will fight and get nothing done… Probably not even getting the full wall.

Can any progress be made on health care if we have all this anger, incivility and progressive socialism?!? Let’s have progress in health care and vows to work for a better future!

News Editor of MedPage, Joyce Frieden remarked that Congress needs to do a better job of funding public health priorities and improving the healthcare system, a group of six physician organizations told members of Congress.

Presidents of six physician organizations — the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association — visited members of Congress as a group here Wednesday to get their message across. The American Medical Association, whose annual Washington advocacy conference takes place here next week, did not participate.

The physician organizations had a series of principles that they wanted to emphasize during their Capitol Hill visits, including:

Helping people maintain their insurance coverage

Protecting patient-centered insurance reforms

Stabilizing the insurance market

Improving the healthcare financing system

Addressing high prescription drug prices

The group also released a list of proposed 2020 appropriations for various federal healthcare agencies, including:

$8.75 billion for the Health Resources and Services Administration

$7.8 billion for the CDC

$460 million for the Agency for Healthcare Research and Quality

$41.6 billion for the National Institutes of Health

$3.7 billion for the Centers for Medicare & Medicaid Services

One of the group’s specific principles revolves around Medicaid funding. “Policymakers should not make changes to federal Medicaid funding that would erode benefits, eligibility, or coverage compared to current law,” the group said in its priorities statement.

This would include programs like the work requirements recently approved in Arkansas and other states; the Kaiser Family Foundation reported in January that more than 18,000 Arkansans have been dropped from the Medicaid rolls for failing to meet the work requirements there.

“Our group is very, very supportive of innovation,” said Ana Maria López, MD, MPH, president of the American College of Physicians, at a breakfast briefing here with reporters. “We welcome testing and evaluation, but we have a very strong tenet that any effort should first do no harm, so any proposed changes should increase — not decrease — the number of people who are insured. Anything that decreases access we should not support.”

That includes work requirements, said John Cullen, MD, president of the American Academy of Family Physicians. “When waivers are used in ways that are trying to get people off of the Medicaid rolls, I think that’s a problem,” he said. “What you want to do is increase coverage.”

Lydia Jeffries, MD, a member of the government affairs committee of the American College of Obstetricians and Gynecologists, agreed. “We support voluntary efforts to increase jobs in the Medicaid population, but we strongly feel that mandatory efforts are against our principal tenets of increasing coverage.”

More $$ for Gun Violence Research

Gun violence research is another focus for the group, which is seeking $50 million in new CDC funding to study firearm-related morbidity and mortality prevention. Kyle Yasuda, MD, president of the American Academy of Pediatrics, explained that gun research stopped in 1997 after the passage of the so-called Dickey Amendment, which prevented the CDC from doing any “gun control advocacy” — that is, accepting for publication obviously biased articles and rejecting any articles that found any positive benefits to gun ownership. Although the amendment didn’t ban the research per se, the CDC chose to comply with it by just avoiding any gun violence research altogether.

Recently, however, Health and Human Services Secretary Alex Azar and CDC Director Robert Redfield, MD, “have provided assurances that the language in the Dickey Amendment would allow for [this] research,” said Yasuda. “We didn’t have research to guide us and that’s what we need to go back to.”

The research is important, said Altha Stewart, MD, president of the American Psychiatric Association, because “in addition to the physical consequences related to gun violence, there’s a long-term psychological impact on everyone involved — both the people who are hurt and the people who witness that hurt. It’s a set of concentric circles that emerges when we talk about the psychological effects of trauma. We often think of [these people] as outliers, but for many people, we work with, this has become all too common in their lives.

“This is definitely our lane as physicians and I’m glad we’re in it,” she said, referring to a popular hashtag on the topic.

Yasuda said the effects of gun violence are nothing new to him because he spent half his career as a trauma surgeon in Seattle. “It’s not just the long-term effect on kids, it is the next generation of kids … It’s the impact on future generations that this exposure to gun violence has on our society, and we just have to stop it.”

The high cost of prescription drugs also needs to be addressed, López said. “We see this every day; people come in and have a list of medications, and you look and see when they were refilled, and see that the refill times are not exactly right … People will say, ‘I can afford to take these two meds on a daily basis, these I have to take once a week’ … They make a plan. [They say] ‘I can fill my meds or I can pay my rent.’ People are making these sorts of choices, and as physicians, it’s our job to advocate for their health.”

One thing the group is staying away from is endorsing a specific health reform plan. “We’re agnostic as far as what a plan looks like, but it has to follow the principles we’ve outlined on consumer protection, coverage, and benefits,” said Cullen. “As far as a specific plan, we have not decided on that.”

Also, Politicians Need To Change The Conversation On How To Fix Health Care

Discussions about Medicare for all, free market care, and Obamacare address one issue – how we pay for health care. The public is tired of these political sound bites and doesn’t have faith in either public or private payment systems to fix their health care woes. Changing the payer system isn’t going to fix the real problem of the underlying cost of care and how it is delivered.

The current system is rotting from the inside. Fee for service payment started the trend with rewarding health care providers for the amount of care they deliver. Through the decades, health care organizations learned how to manipulate the system to maximize profit. Remember, at no time has an insurer lost money. They just increase premiums and decrease reimbursements to health care facilities and caregivers and constrict their coverage. Insurers retaliated by creating more hoops to jump through to get services covered. This includes both Medicare and private insurance.

Who is left to deal with the quagmire? The patients. Additionally, the health care professionals who originally entered their profession to take care of people became burned out minions of the health care machine. Now we are left with an expensive, fragmented health care system that costs three times more than the average costs of other developed countries and has much poorer health outcomes.

Our country needs a fresh conversation on how to fix our health care system. The politicians who can simplify health care delivery and provide a plan to help the most people at a reasonable cost will win the day. There are straightforward fixes to the problem.

About 75% of the population needs only primary care. Early hypertension, diabetes, and other common chronic issues can be easily cared for by a good primary care system. This will reduce the progression of a disease and reduce costs down the line. Unfortunately, the fee for service system has decimated our primary care workforce through turf wars and payment disparities with specialty care and we now have a severe primary care shortage. Patients often end up with multiple specialists which increases cost, provides unsafe and fragmented care, and decreases patient productivity.

Insurance is meant to cover only high cost or rare events. Primary care is inexpensive and is needed regularly, so it is not insurable. We pay insurance companies 25% in overhead for the privilege of covering our primary care expenses. Plus, patients and their doctors often must fight insurance companies to get services covered. The lost productivity for patients and care providers is immeasurable.

In a previous article, the author shared the proposal of creating a nationalized network of community health centers to provide free primary care, dental care, and mental health care to everyone in this country.

Community health centers currently provide these services for an average cost of less than $1,000 per person per year. By providing this care free to all, we can remove primary care from insurance coverage, which would reduce the cost of health insurance premiums.

Free primary care would improve population health, which will subsequently reduce the cost of specialty care and further reduce premiums.

Community health centers can serve as treatment centers for addiction, such as our current opioid crisis, and serve as centers of preparedness for epidemic and bioterrorist events.

People who do not want to access a community health center can pay for primary care through direct primary care providers.

This idea is not unprecedented – Spain enacted a nationwide system of community health centers in the 1980s. Health care measures, patient satisfaction, and costs improved significantly.

By providing a free base of primary care, dental care, and mental health care to everyone in this country, we can improve health, reduce costs, and improve productivity while we work toward fixing our health care payment system.

Current Community Health Centers

Community health centers currently serve approximately 25 million low-income patients although they have the structural capacity to serve many more. This historical perspective of serving low-income individuals may be a barrier to acceptance in the wider population. In fact, when discussing this proposal with a number of health economists and policy people, many felt the current variability in the quality of care would discourage use of community health centers in all but a low-income population. Proper funding, a culture of care and accountability, and the creation of a high functioning state of the art facilities would address this concern.

There are currently a number of community health centers offering innovative care, including dental and mental health care. Some centers use group care and community health workers to deliver care to their communities. Many have programs making a serious dent in fighting the opioid epidemic. Taking the best of these high functioning clinics and creating a prototype clinic to serve every community in our nation is the first step in fixing our health care system

The Prototype Community Health Center – Delivery of Care

Community health centers will be built around the patient’s needs. Each clinic should have:

Extended and weekend hours to deliver both acute and routine primary care, dental care, and mental health care. This includes reproductive and pediatric care.

Home visits using community health workers and telemedicine to reach remote areas, homebound, and vulnerable populations such as the elderly.

A pharmacy that provides generic medications used for common acute and chronic illnesses. Medication will be issued during the patient’s visit.

There will be no patient billing. Centers will be paid globally based on the population they serve.

The standard of care will be evidence-based for problems that have evidence-based research available. If patients desire care that is not evidence based, they can access it outside the community health system and pay for that care directly. For problems that do not have evidence-based research, basic standards of care will apply.

It will be very important that both providers and patients understand exactly what services will be delivered. By setting clear expectations and boundaries, efficiency can be maintained and manipulation of the system can be minimized.

The Prototype Community Health Center – Staffing

The clinics would be federally staffed and funded. Health care providers and other employees will receive competitive salary and benefits. To attract primary care providers, school loan repayment plans can be part of the compensation package.

The “culture” of community health centers must be codified and will be an additional attraction for potential employees. A positive culture focused on keeping patients AND staff healthy and happy, open communication, non-defensive problem solving, and an attitude of creating success should be the standard. Bonuses should be based on the quality of care delivery and participation in maintaining good culture.

One nationalized medical record system will be used for all community health centers. The medical records will be built solely for patient care. Clinical decision support systems can be utilized to guide health care providers in standards of diagnosis and treatment, including when to refer outside the system.

Through the use of telemedicine, basic consultation with specialists can be provided but specialists will consult with the primary care physicians directly. One specialist can serve many clinics. For example, if a patient has a rash that is difficult to diagnose, the primary care doctor will take a picture and send it to the dermatologist for assistance.

For services beyond primary care and basic specialty consultation, insurance will still apply. The premiums for these policies will be much lower because primary care will be excluded from coverage.

How to get “there” from “here”

Think Starbucks – after the development of the prototype design based on currently successful models, with proper funding, centers can be built quickly. Attracting primary care providers, dentists, and mental health care providers will be key to success.

Basic services can be instituted first – immunizations, preventive care, reproductive care, and chronic disease management programs can be standardized and easily delivered by ancillary care providers and community health workers. Epidemic and bioterrorist management modules can be provided to each center. As the primary care workforce is rebuilt, further services can be added such as acute care visits, basic specialty consultations, and expanded dental and mental health care.

With the implementation of this primary care system, payment reform can be addressed. Less expensive policies can immediately be offered that exclude primary care. Ideally, we will move toward a value-based payment system for specialty care. The decision on Medicare for all, a totally private payer system, or a public and private option can be made. Thankfully, during the political discourse, 75% of the population will have their needs fully met and our country will start down the road to better health.

Christopher Zara reported that in today’s edition of “Ask and Ye Shall Receive,” here’s more evidence that support for universal health care isn’t going away.

The Twitter account for Fox & Friends this week ran a poll in which it asked people if the benefits of Bernie Sanders’s “Medicare for All” plan would outweigh the costs. The poll cites an estimated cost of $32.6 trillion. Hilariously, 73% of respondents said yes, it’s still worth it—which is not exactly the answer you’d expect from fans of the Trump-friendly talk show.

Granted, this is just a Twitter poll, which means it’s not scientific and was almost certainly skewed by retweets from Twitter users looking to achieve this result.

At the same time, it’s not that far off from actual polling around the issue. In March, a Kaiser Health tracking poll revealed that 6 in 10 Americans are in favor of a national healthcare system in which all Americans would get health insurance from a single government plan. Other polls have put the number at less than 50% support but trending upward.

If you’re still unsure, you can read more about Sanders’s plan and stay tuned for more discussion on “Medicare for All”.

Should we all be even concerned about any of these health care problems if AOC is right and the world ends in 12 years? Good young Ocasio Cortez, if she only had ahold on reality!! Her ideas will cost us all trillions of dollars, tax dollars, which we will all pay! Are we all ready for the Green Revolution?

Actually, I thought that President Trump did a good job even being conciliatory in his State of the Union speech even covering various aspects of healthcare. Joyce Frieden the News Editor of MedPage stated that Healthcare played a major part in Tuesday’s State of the Union address, with President Trump covering a wide variety of health-related topics.

Only a few minutes into the speech, the president foreshadowed some of his healthcare themes. “Many of us have campaigned the same core promises to defend American jobs and … to reduce the price of healthcare and prescription drugs,” Trump said. “It’s a new opportunity in American politics if only we have the courage together to seize it.”

A few minutes later, he touted some of his administration’s actions so far. “We eliminated the very unpopular Obamacare individual mandate penalty,” Trump said. “And to give critically ill patients access to lifesaving cures, we passed — very importantly — the right to try.”

Drug Prices a Major Player

The subject of drug prices occupied a fair amount of time. “The next major priority for me, and for all of us, is to lower the cost of healthcare and prescription drugs and to protect patients with preexisting conditions,” he said. “Already, as a result of my administration’s efforts in 2018, drug prices experienced their single largest decline in 46 years. But we must do more. It’s unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place.”

“This is wrong; this is unfair, and together we will stop it, and we’ll stop it fast,” he said. “I am asking the Congress to pass legislation that finally takes on the problem of global freeloading and delivers fairness and price transparency for American patients, finally.”

He then turned to several other health topics. “We should also require drug companies, insurance companies, and hospitals to disclose real prices, to foster competition, and bring costs way down,” Trump said. He quickly moved on to the AIDS epidemic. “In recent years we’ve made remarkable progress in the fight against HIV and AIDS. Scientific breakthroughs have brought a once distant dream within reach. My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years.”

“We have made incredible strides, incredible,” he added to applause from members of Congress on both sides of the aisle. “Together we will defeat AIDS in America and beyond.”

Childhood Cancer Initiative

Although the remarks on HIV had been expected, the president also announced another health initiative that wasn’t as well-known: a fight against childhood cancer. “Tonight I’m also asking you to join me in another fight all Americans can get behind — the fight against childhood cancer,” he said, pointing out a guest of First Lady Melania Trump: Grace Eline, a 10-year-old girl with brain cancer.

“Every birthday, since she was 4, Grace asked her friends to donate to St. Jude’s Children’s Hospital,” Trump said. “She did not know that one day she might be a patient herself [but] that’s what happened. Last year Grace was diagnosed with brain cancer. Immediately she began radiation treatment, and at the same time she rallied her community and raised more than $40,000 for the fight against cancer.”

“Many childhood cancers have not seen new therapies in decades,” he said. “My budget will ask Congress for $500 million over the next 10 years to fund this critical life-saving research.”

These health initiatives met with mixed reactions. “President Trump is taking a bold step to design an innovative program and strategy, and commit new resources, to end HIV in the United States … Under the President’s proposal, the number of new infections can eventually be reduced to zero,” Carl Schmid, deputy executive director of The AIDS Institute, said in a statement. Michael Ruppal, the institute’s executive director, added, “While we might have policy differences with the president and his administration, this initiative if properly implemented and resourced, can go down in history as one of the most significant achievements of his presidency.”

But the Democratic National Committee (DNC) wasn’t quite so enthusiastic; it sent an email calling the goal of ending HIV by 2030 “notable” but added, “The Trump administration has consistently undermined advancements in HIV/AIDS research, attacked people living with HIV/AIDS, and sabotaged access to quality healthcare at every opportunity.” Among other things, the administration redirected money from the Ryan White HIV/AIDS Program to help fund the separation of immigrant families, and proposed cutting global HIV/AIDS funding by over $1 billion, which could cause 300,000 deaths per year, the DNC said.

Abortion in the Spotlight

As for the childhood cancer initiative, “$500 million over 10 years to solve childhood cancer is … not a lot,” one Bloomberg reporter tweeted. However, Gail Wilensky, Ph.D., a senior fellow at Project HOPE, in Bethesda, Maryland, pointed out that this amount ” is in addition to the National Institutes of Health budget [for cancer] … A lot of money is going to cancer anyway [already] and the National Cancer Institute been one of the more protected parts of government, so it’s not like they have a big deficit to make up.”

Overall, “it was a surprisingly good speech,” said Wilensky, who was the administrator of the Centers for Medicare & Medicaid Services under President George H.W. Bush. “It covered a lot of areas, and there were a number of issues that were very hard not to applaud … I thought he did a pretty admirable job of forcing applause and a sense of togetherness by the country, talking about compromise and the common good.”

The president also touched on a more controversial area of healthcare: abortion. He referred to a recent abortion bill that passed in New York State and another that failed in Virginia — both of which dealt with abortion late in pregnancy — adding, “I’m asking Congress to pass legislation to prohibit late-term abortion of children who can feel pain in a mother’s womb. Let us work together to build a culture that cherishes innocent life.”

That appeal to the anti-abortion movement “is a position that Republicans have taken in the past, which is the importance of life right after birth and life right before birth,” said Wilensky. Abortion later in pregnancy “is an area that tends to engender a more unified response than most others, even for people who are ambivalent or more supportive of abortion rights. Very late-term abortion makes people uncomfortable … It’s easy to understand why people get uneasy.”

“Already, the biggest move the Trump administration has made to control health care costs and access has been on the regulatory front,” said Bob Laszewski, founder of Health Policy and Strategy Associates, an Alexandria, Virginia, consulting firm, citing the announcement of proposed regulations to end drug rebates under Medicare and Medicaid kickback rules and rules for short-term health plans. “I take it from Trump’s remarks that they will continue with this regulatory approach instead of waiting for any bipartisanship in the Congress,” he said.

“The only area there now seems to be a hint of bipartisanship is over the issue of drug prices being too high,” Laszewski added. “It was clear from Trump’s remarks, and the Democrats’ positive response on this one issue, that this could become an area for cooperation.”

No Large-Scale Reforms Offered

Rosemarie Day, a healthcare consultant in Somerville, Massachusetts, said in an email that the president “certainly did not propose any large-scale reforms to the healthcare system during the speech, and he was short on specifics for most of it. According to a recent Kaiser Family Foundation poll, health care is the number one issue among voters so this may appear to some as a missed opportunity. It’s increasingly looking like Republicans are leaving the big health care reform ideas to the Democratic presidential candidates.”

The ideas he did propose “were mostly noncontroversial and somewhat vague,” Day continued. “The more interesting proposal was lowering the cost of healthcare and drugs, which is a high priority for consumers. The way he discussed going about it was by requiring drug companies, insurance companies, and hospitals to disclose real prices. This raises many questions, such as what does a ‘real’ price mean? … This will be an interesting area to watch, since ‘real prices’ are currently closely held secrets, and a legal requirement to disclose them would constitute a significant change from the status quo.”

In the Democratic response to the speech, Stacey Abrams, a Democrat who ran unsuccessfully last year for governor of Georgia, lashed out against enemies of Obamacare. “Rather than suing to dismantle the Affordable Care Act as Republican attorneys general have, our leaders must protect the progress we’ve made and commit to expanding healthcare and lowering costs for everyone,” said Abrams, the first black woman to deliver the rebuttal to a State of the Union address.

She also spoke of her personal struggle with healthcare costs for her family. “My father has battled prostate cancer for years. To help cover the costs, I found myself sinking deeper into debt because, while you can defer some payments, you can’t defer cancer treatment. In this great nation, Americans are skipping blood pressure pills, forced to choose between buying medicine and paying rent.”

She also pushed back against state governors and legislators who continue their resistance to Medicaid expansion. “In 14 states, including my home state, where a majority want it, our leaders refused to expand Medicaid which could save rural hospitals, save economies and save lives.”

With Dems now in charge, repeal-and-replace no longer on the table!

Former Rep. John Dingell Left An Enduring Health Care Legacy

If anyone is interested in healthcare and its history here in the U.S. one must include the legacy of former Rep. John Dingell, the Michigan Democrat who holds the record as the longest-serving member of the U.S. House, died Thursday night in Michigan. Julie Rovner reviewed his history last week after his death. He was 92.

And while his name was not familiar to many, his impact on the nation, and on health care, in particular, was immense.

For more than 16 years Dingell led the powerful House Energy and Commerce Committee, which is responsible for overseeing the Medicare and Medicaid programs, the U.S. Public Health Service, the Food and Drug Administration and the National Institutes of Health.

Dingell served in the House for nearly 60 years. As a young legislator, he presided over the House during the vote to approve Medicare in 1965.

As a tribute to his father, who served before him and who introduced the first congressional legislation to establish national health insurance during the New Deal, Dingell introduced his own national health insurance bill at the start of every Congress.

And when the House passed what would become the Affordable Care Act in 2009, leaders named the legislation after him. Dingell sat by the side of President Barack Obama when he signed the bill into law in 2010.

Dingell was “a beloved pillar of the Congress and one of the greatest legislators in American history,” said a statement from House Speaker Nancy Pelosi. “Yet, among the vast array of historic legislative achievements, few hold greater meaning than his tireless commitment to the health of the American people.”

He was not always nice. Dingell had a quick temper and a ferocious demeanor when he was displeased, which was often. Witnesses who testified before him could feel his wrath, as could Republican opponents and even other committee Democrats. And he was fiercely protective of his committee’s territory.

In 1993, during the effort by President Bill Clinton to pass major health reform, as the heads of the three main committees that oversee health issues argued over which would lead the effort, Dingell famously proclaimed of his panel, “We have health.”

Dingell and his health subcommittee chairman, California Democrat Henry Waxman, fought endlessly over energy and environmental issues. Waxman, who represented an area that included western Los Angeles, was one of the House’s most active environmentalists. Dingell represented the powerful auto industry in southeastern Michigan and opposed many efforts to require safety equipment and fuel and emission standards.

In 2008, Waxman ousted Dingell from the chairmanship of the full committee.

But the two were of the same mind on most health issues, and together during the 1980s and early 1990s they expanded the Medicaid program, reshaped Medicare and modernized the FDA, NIH and the Centers for Disease Control and Prevention.

“It was always a relief for me to know that when he and I met with the Senate in the conference, we were talking from the same page, believed in the same things, and we were going to fight together,” Waxman said in 2009.

Dingell was succeeded in his seat by his wife, Rep. Debbie Dingell, herself a former auto industry lobbyist.

House Panel Mulls ACA Fixes, Responses to Trump Policies

Now to the article of the week, Ryan Basen, a writer for MedPage noted that focusing on preventive care, expanding subsidies, and regulating association health plans (AHPs) were among the solutions proposed Tuesday to aid Americans with pre-existing health conditions, as the U.S. House Ways and Means Committee held its first hearing under the new Congress.

While the hearing was entitled “Protecting Americans with Pre-Existing Conditions,” much discussion centered around the policies within the Affordable Care Act, Republican efforts to repeal it, and recent reforms that tweaked American healthcare. Many lawmakers used their allotted time to blast other party members for either being too supportive of the ACA or attempting to “sabotage” it. Some lawmakers, however, promised to work together with members of the opposing party to help patients with pre-existing conditions — which some noted includes themselves and family members.

“Protections for people with pre-existing conditions has become the defining feature of the Affordable Care Act,” said witness Karen Pollitz, a senior fellow with the Kaiser Family Foundation; she noted that these protections also enjoy widespread public support.

The ACA forced insurance plans to accept and retain members with pre-existing conditions, many of whom could not afford plans before the legislation was enacted. But Trump administration policies and other reforms worry some experts and lawmakers that the millions of American with pre-existing conditions — ranging from moderate mental health diagnoses to cancer — are gradually being priced out of the healthcare system again, they said.

Protecting patients with pre-existing conditions are linked to controlling costs throughout American healthcare, many said. Recent legislation led to “artificial” cost increases for ACA marketplace plans and pushed some insurers to leave the market altogether, Pollitz said. These policies also have driven up premium prices.

“What we have here is an infrastructure problem,” Rep. John Larson (D-Conn.) said. “The disagreements are over how to pay for it.”

“All we are really debating here is who gets to pay,” Rep. David Schweikert (R-Ariz.) said. “It’s time for radical rethinking: Are you [Democrats] willing to work with us to break down the barriers to having cost disruption?”

Several who spoke Tuesday offered potential solutions. Witness Keysha Brooks-Coley, of the American Cancer Society Cancer Action Network, suggested lawmakers strengthen the ACA by addressing its so-called “family glitch” and eliminating the “subsidy cliff”; both policies currently withhold subsidies from many Americans who need them to pay for healthcare, she said.

Rep. Brad Wenstrup, DPM (R-Ohio), called for turning lawmakers’ focus from squabbling about politics to studying preventative care. “There’s no part of me as a doctor that doesn’t want Americans to have access to quality healthcare,” the podiatrist said. “But I don’t necessarily agree with the direction (the ACA) went.”

“Let’s talk about incentivizing health: What do we have not only for the patient but for the physician?” he added. “Think about who gets rewarded in today’s system. Do we recognize the doctor who prevented the patient from needing open-heart surgery? That’s where we need to go if you want to talk about the cost curve.”

One solution is actually quite simple, according to witness Rob Roberston, secretary-treasurer for the Nebraska Farm Bureau: regulate AHPs and encourage individuals to band together in groups to reduce premium costs, as many farmers and ranchers have in Nebraska. “This is not a political issue,” he said. “This is an issue of hardship, and we need to fix these individual markets and protect pre-existing conditions at the same time.”

Alas, judging by many lawmakers’ tone during a hearing that stretched over four hours, this does appear to be a political issue. “It’s really this long debate over Obamacare,” Rep. Devin Nunes (R-Calif.) said. “We really need to work for a solution because Obamacare wasn’t a solution.”

Rep. Lloyd Doggett (D-Texas) then got into it. “What has led us here has been eight years of Republican persistence in trying to destroy the Affordable Care Act,” he said. “It’s great to hear they [Republicans] want to work with us and I hope they do.” The ACA is not perfect, Doggett acknowledged, but he quipped that perhaps “the most pre-existing condition” present Tuesday was “the political amnesia of those who have forgotten what it was like before the Affordable Care Act.”

Raising his voice, Rep. Earl Blumenauer (D-Ore.) echoed the point: “If we would have been working together for the last six years to refine the Affordable Care Act, costs would be lower, coverage would be better.”

Many witnesses spoke against the Administration’s policy to loosen regulations on cheaper short-term plans that do not have to abide by ACA strictures. “The expansion of these plans does not help the consumer,” Brooks-Coley said. “It puts them at increased risk. … They are only less expensive upfront because they don’t cover [serious conditions].” In addition, Pollitz noted, many of these plans drop patients once they become ill and “have been shown to increase costs of ACA-compliant plans.”

The witnesses were asked to gauge what would happen if protections for patients with pre-existing conditions were to be removed. Younger women would pay more than men the same age, Pollitz said, and all pre-existing patients “would find it much more difficult to find coverage.”

“True harm would come,” Andrew Stolfi, Oregon Division of Financial Regulation’s insurance commissioner, told the committee. He cited Oregon’s pre-ACA experience: “You were lucky if you were even given the choice to take an insurer’s limited terms.”

Ways and Means chairman Richard Neal (D-Mass.) ended the hearing with optimism: “Today I heard a lot of members on the other side of the aisle say they support [requiring coverage for] pre-existing conditions, and I welcome that and hope we can work together.”

So, now what do the physicians think is needed to improve our health care system? Next week let’s discuss.

The children in Washington are still fighting over the wall but, my wife found out why I’m not a fan of Medicare-For-All this past weekend. She finally found out how expensive it is for our family, which is just the two of us. She added up the fees, including secondary insurance, etc. and it came up with a yearly cost of $13,000. So, there is nothing free here. And if the government pays these costs to imagine the cost and who is going to pay for this program?

Jack Crowe from the National Review reported that Senator Kamala Harris (D., Calif.) advocated the elimination of the private health insurance industry during a CNN town hall event in Iowa Monday night.

Harris, who announced her 2020 presidential candidacy this week, broke from previous Democratic healthcare orthodoxy, which held that Americans could retain their private insurance if they so chose, in favor of a single-payer plan in which the government is the sole health insurance provider.

“I believe the solution — and I actually feel very strongly about this — is that we need to have Medicare for all,” Harris said in response to an audience question about healthcare affordability. “That’s just the bottom line.”

“So for people out there who like their insurance, they don’t get to keep it?” CNN’s Jake Tapper asked.

“Let’s eliminate all of that,” Harris responded, “let’s move on.”

Harris went on to describe the current healthcare system as “inhumane” and argued that switching over to a single payer system would reduce the financial and bureaucratic barriers to quality health care.

“Well, listen, the idea is that everyone gets access to medical care, and you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require,” she said. “Who of us has not had that situation where you’ve got to wait for approval, and the doctor says, well, I don’t know if your insurance company is going to cover this. Let’s eliminate all of that. Let’s move on.”

Employing the language of human rights, the Democratic establishment has increasingly embraced “Medicare For All” in recent years as young, healthy Americans — previously burdened by the threat of a punitive tax on the uninsured, which the Trump administration recently eliminated — have increasingly fled government exchanges, exposing older, sick consumers to even steeper premiums.

The policy, which is widely viewed as a litmus test among potential Democratic presidential candidates, mandates that every American purchase their health insurance through the government. It would require $32.6 trillion in new spending over ten years, according to the Mercatus Center. Doubling the corporate and individual income tax would not cover the cost of the program, according to the analysis.

Jack Crowe then followed up on this announcement by Harris noting that after advocating the elimination of the private insurance market during CNN’s town hall in Iowa Monday night, Senator Kamala Harris (D., Calif.) appeared to backtrack on Tuesday amid criticism from moderate Democrats and Republicans alike.

Remember her announcement “Let’s eliminate all of that,” Harris said when asked by CNN’s Jake Tapper if, under her proposed “Medicare For All” proposal, Americans with private insurance plans could retain them.

“Let’s move on,” she added.

The remarks immediately drew condemnation from former Starbucks CEO Howard Schultz, who recently launched an independent bid for president, and Mike Bloomberg, the centrist former mayor of New York City.

In response, Harris’s national press secretary Ian Sams and an unnamed advisor told CNN that she would also be open to pursuing more moderate healthcare reforms that would allow the 177 million Americans currently using private health insurance plans to keep them.

“Medicare-for-all is the plan that she believes will solve the problem and get all Americans covered. Period,” Sams told CNN. “She has co-sponsored other pieces of legislation that she sees as a path to getting us there, but this is the plan she is running on.”

During her time in the Senate, Harris has co-sponsored Senator Bernie Sanders (D., Vt.) “Medicare For All” bill, which would entirely phase out the private insurance industry, but has also proven willing to embrace the more moderate “public option,” which would allow more Americans to buy into Medicaid while leaving the private market largely intact.

Kamala Harris and the Implausibility of ‘Medicare-for-All’

Then Rich Lowry noted that Senator Kamala Harris committed a most unusual gaffe at her CNN town hall the other night — not by misspeaking about one of her central policy proposals, but by describing it accurately.

Asked on Monday night if the “Medicare-for-all” plan that she’s co-sponsoring with Senator Bernie Sanders eliminates private health insurance, she said that it most certainly does. Citing insurance company paperwork and delays, she waved her hand: “Let’s eliminate all of that. Let’s move on.”

She met with approbation from the friendly audience in Des Moines, Iowa, but the reaction elsewhere was swift and negative.

“As the furor grew,” CNN reported the next day, “a Harris adviser on Tuesday signaled that the candidate would also be open to the more moderate health reform plans, which would preserve the industry, being floated by other congressional Democrats.”

This was a leading Democrat wobbling on one of her top priorities 48 hours after the kickoff of her presidential campaign, which has been praised for its early acumen. It is sure to be the first of many unpleasant encounters between the new Democratic agenda and political reality.

Democrats are now moving from the hothouse phase of jockeying for the nomination, when all they had to do was get on board the party’s orthodoxy as defined by Bernie Sanders, to defending these ideas in the context of possibly signing them into law as president of the United States.

The Harris flap shows that insufficient thought has been given to how these proposals will strike people not already favorably disposed to the new socialism. It’s one thing for Sanders to favor eliminating private health insurance; no one has ever believed that he is likely to become president. It’s another for Harris, deemed a possible front-runner, to say it.

Her position is jaw-droppingly radical. It flips the script of the (dishonest) Barack Obama pledge so essential to passing Obamacare: “If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.”

That was a very 2009 sentiment. Ten years later, Harris indeed wants to take away your health plan, not in a stealthy operation, not as an unfortunate byproduct of the rest of her plan, but as a defining plank of her agenda.

This is a far more disruptive idea than Senator Elizabeth Warren’s wealth tax. The affected population isn’t a limited group of highly affluent people. It is half the population, roughly 180 million people who aren’t eager for the government to swoop in and nullify their current health-care arrangements.

They may not like the current system, but they like their own health care — about three-quarters tell Gallup that their own health care is excellent or good. This is why the relatively minor interruption of private plans as part of the rollout of Obamacare was so radioactive.

How is a President Harris going to overcome this kind of resistance absent Depression-era Democratic supermajorities in Congress? Not to mention pay for a program that might well cost $30 trillion over 10 years and beat back fierce opposition from key players in the health-care industry?

She obviously won’t. “Medicare-for-all” is a wish and a talking point rather than a realistic policy. When her aides say she is willing to accept another “path” to “Medicare-for-all,” what they mean is that Harris is willing to accept something short of true “Medicare-for-all.”

There is always something to be said for shifting the Overton window on policy. But it’s better if think tanks and gadflies rather than plausible presidential candidates who aren’t even trying to hold down the left flank of the party do that.

If it’s uncomfortable for Kamala Harris to defend eliminating private health insurance now, imagine what it will be like when the entire apparatus of the Republican Party — including the president’s Twitter feed — is aimed at her in a general election.

What do Californians think about Kamala Harris’ far-left agenda?

Campus Reform editor-in-chief Lawrence Jones hit the streets of Los Angeles to see how people view the 2020 Democratic presidential candidate’s progressive proposals.

People expressed enthusiasm for Harris’ agenda, which includes Medicare-for-all, free college and rolling back President Trump’s tax plan.

When asked how they would pay for healthcare and college for every American, people responded with “Figure it out!” and “It’s in someone’s pockets, so why not share?”

On “Fox & Friends” Thursday, Jones said he spoke to many people who acknowledged that Harris’ agenda is not affordable or practical, but they like her and what she’s saying.

“This just shows you where this emotion-driven, progressive policy has taken this country,” Jones said.

He said Campus Reform has explored that troubling trend on college campuses, and now he’s increasingly seeing it among adults.

“That’s why people should be concerned because Obama won because he connected with voters,” Jones said. “Let’s see what happens now.”

‘Medicare-for-all’ means long waits for poor care, and Americans won’t go for it once they learn these facts

Progressive Democrats push ‘Medicare-for-all’ platform.

Critics say to provide ‘Medicare-for-all,’ taxes would have to go up while quality, choice, and access to care would go down; chief congressional correspondent Mike Emanuel reports.

Sally Pipes of Fox News pointed out that this week, as I have already stated, Sen. Kamala Harris, D-Calif., one of the front-runners in the race for the Democratic Party’s presidential nomination, revealed her radical vision for American health care – outlawing private health insurance and putting the government in charge of the system.

Harris, along with 15 of her Democratic colleagues, supports Sen. Bernie Sanders’, I-Vt., the vision of “Medicare-for-all.” Sanders’ 2017 bill, S.1804, was explicit about outlawing private health insurance. At a town hall in Iowa last Again, remember Monday when Harris confirmed she was on board with that idea. “Let’s eliminate all of that,” she said.

In other words, Harris is running for president on a platform of taking away the private insurance coverage of about 200 million people and dumping everyone into a one-size-fits-all government-run health plan that would cost taxpayers trillions of dollars. And if the experiences of other countries with single-payer health care are any indication, it would result in long waits for poor care.

I’M A NOT A DEMOCRAT, ACTUALLY AN INDEPENDENT, BUT MEDICARE FOR ALL IS NOT THE ANSWER — HERE ARE FOUR SUGGESTIONS

Support for single-payer appears to be the price of admission to the Democratic presidential race. Harris’s fellow presidential aspirants, Sens. Elizabeth Warren, D-Mass., Kirsten Gillibrand, D-N.Y., and Cory Booker, D.-N.J., were among the co-sponsors of Sanders’ 2017 “Medicare-for-all” legislation. And it’s only a matter of time before Sanders himself, the pied piper of the “Medicare-for-all” movement, joins the race.

“Medicare-for-all’s” advocates promise a health care system that’s free at the point of service – no co-pays, no deductibles, no coinsurance.

They tend to be less upfront about how they’d pay for it. Independent estimates from both the right and the left peg “Medicare-for-all’s” cost at about $32 trillion over 10 years. Doubling what the federal government takes in individual and corporate income tax revenue wouldn’t be enough to cover that tab.

That’s assuming “Medicare-for-all” is able to implement its financing strategy. The bill proposes reimbursing doctors and hospitals at Medicare’s current rates, which are 40 percent below what private insurance pays.

Health care providers are unlikely to just absorb those cuts. Those with narrow margins – say, in rural areas – may be forced to close, unable to cover their costs. Some doctors may respond to lower payments by seeing fewer patients, retiring early, or leaving the practice of medicine altogether. Bright young people may decide not to pursue careers in medicine, given that “Medicare for all” will limit their earning power.

Regardless, ratcheting down the price of care by force is going to cause health care providers to supply less of it. And that will lead to longer waits for patients.

American patients will not stand for the higher taxes and lower-quality care that “Medicare-for-all” would bring.

Long waits plague patients in other countries with government-run health care. Take Canada, which outlaws private health insurance for anything considered medically necessary, just as “Medicare for all” would. The median wait for treatment from a specialist following referral by a general practitioner is 19.8 weeks, according to the Fraser Institute, a Vancouver-based think tank. In 1993, the median wait was less than half as much – 9.3 weeks.

Waits are far longer for some specialties. For orthopedic surgery, the median wait for specialist treatment is 39 weeks.

Many Canadians are uninterested in waiting multiple months for treatment, particularly if they’re in pain or fear they may have a serious illness. So they pay out of pocket for care abroad. In 2016, more than 63,000 Canadians went to another country to receive medical treatment.

On the other side of the Atlantic, the United Kingdom’s government-run, 70-year old National Health Service, is proving similarly incapable of providing quality care. The system is currently short 100,000 health professionals – doctors, nurses, and other workers.

It’s no wonder 14 percent of operations are canceled right before they are supposed to happen, usually due to a shortage of staff or beds. Last July, 4.3 million patients were waiting for an operation – the highest figure in a decade.

During the winter, the system goes into crisis mode. Between December 2017 and February 2018, more than 163,000 patients waited in corridors and ambulances for over 30 minutes before being admitted to the emergency room. To deal with the crunch, officials ordered hospitals to cancel 50,000 operations.

American patients will not stand for the higher taxes and lower-quality care that “Medicare-for-all” would bring. A majority of people, 55 percent, erroneously believes that they’d be able to keep their private insurance under such a system. Once they learn it would eliminate private health insurance, support for the idea plummets, from 56 percent to 37 percent. The same happens after they learn it would require higher taxes.

Seven in 10 Americans say they’d oppose “Medicare-for-all” if it led to delays in getting some treatments and tests. Such delays are not hypothetical – they’re endemic to single-payer.

Harris and her fellow Democrats may think “Medicare-for-all” is their ticket to the White House. But voters are not interested in their plan to eliminate private health insurance.

And now, this past week, one of the potential Presidential candidates Senator Kirsten Gillibrand a backer of Medicare-For-All, announced that she thought that Medicaid-For-All made sense also. Really, do you all know what Medicaid pays the physicians???? 10 cents on the dollar, which is why my practice doesn’t accept any Medicaid patients. But maybe for primary care using nurse practitioners and physician assistants, this might work as basic care for “All”.